Manur - Retrograde Intubation Technique

Retrograde Intubation Technique

On 3^rd march 2021, A 62 year Old male  patient admitted with Left sided CA Buccal Mucosa recurrence 1^st time he has been operated for Commando surgery at Hyderabad few years back, but after few years again got signs and symptoms, so we planned to redo Commando Surgery at our Manur multispeciality hospital in Gulbarga.

 Anaesthesia point of view patient had mouth opening of less than of one finger with MPC grade IV with scarred pus filled flaps on left side of the check. we planned to go with retrograde intubation technique to pass the ETT through seldinger technique to avoid tracheostomy. So, the pectoral flap can be anastomised properly infront of the neck, after thorough councelling with the patient planned to go with Retrograde Intubation Technique.

Procedure: 2% local Lygnicane infiltration is given at the level of Cricoid Cartilage and with 18 guage Touheys Epidural needle introduced by puncturing the Cricoid cartilage and confirmed the position of Trachea by negative aspiration. Epidural catheter is introduced by directing upwards for few centimetres. Once the catheter is seen at the floor of the mouth, it is pulled out by Magill Forceps and 8 french infant feeding tube is introduced into the nose, it also seen floor of the mouth and pulled out from the mouth by Magiles forceps. Now the catheter is threaded into the infant feeding tube. Then infant feeding tube is pulled out from the same nostril till the catheter comes out of the nose. Now  the epidural catheter is introduced from treachea which is pulled out from the nostril, Followed by 7.5 no ETT armoured flexo metallic tube is introduced over the epidural catheter through the nostril after adequate jelly is applied. once the ET tube bypasses the Vocal cord and catheter is pulled out from nostrils  and the position of ETT Confirmed by ETCo2.  Patient is induced with Aneasthetic medication and surgery is proceeded.

Greatful benefit to the patient: We avoided Tracheostomy and its related complications. So done with successful Retrograde Intubation at Manur Multispeciality Hospital. Patient is discharged after 10 days of ICU management.